Behavioral adjustment of siblings of children with autism engaged in applied behavior analysis early intervention programs: the moderating role of social support

There have been few studies of the impact of intensive home-based early applied behavior analysis (ABA) intervention for children with autism on family functioning. In the present study, behavioral adjustment was explored in 78 siblings of children with autism on ABA programs. First, mothers' ratings of sibling adjustment were compared to a normative sample. There were no reported increases in behavioral adjustment problems in the present sample. Second, regression analyses revealed that social support functioned as a moderator of the impact of autism severity on sibling adjustment rather than a mediator or compensatory variable. In particular, siblings in families with a less severely autistic child had fewer adjustment problems when more formal social support was also available to the family. The implications of these data for future research and for practice are discussed.     

Brief Report: Fathers’ and Mothers’ Ratings of Behavioral and Emotional Problems in Siblings of Children with Autism Spectrum Disorder

Debate is ongoing about whether typically developing siblings of children with autism spectrum disorder (ASD) are at greater risk of behavioral or emotional problems than siblings of children without ASD. Most data on behavior is provided by mothers, and we do not know whether fathers’ reports differ. The strengths and difficulties questionnaire (Goodman in J Child Psychol Psychiatry 38(5):581–586, 1997) was completed by 168 mothers and 130 fathers. Parents were more likely to rate siblings as having ‘abnormal’ behavior when compared to a normative population. We found moderate correlations between mother–father ratings. More research may be needed to understand any clinical benefits of gathering data about sibling adjustment from more than one parent in the family. Implications for clinical practice and future research are discussed.     

Factors influencing adjustment in siblings of children with autism spectrum disorders

Siblings of children with autism spectrum disorders (ASD) may be at an increased risk of adjustment problems. To examine possible predictors of adjustment difficulties in siblings, 70 mothers with at least one child with ASD and one typical child completed surveys of symptom severity in the child with ASD, impact of the child with ASD on the sibling, maternal depression, and broader autism phenotype (BAP) and behavioral adjustment in the typical sibling. A path analysis indicated that symptom severity in the children with ASD was positively associated with adjustment difficulties in the typical siblings; this relationship was mediated by maternal depression, but not sibling impact. Further, greater expression of the BAP in the siblings was associated with more adjustment difficulties, and this relationship was moderated by autism severity in the children with ASD, such that the relationship was stronger at high levels of ASD severity than at lower levels. These findings highlight the importance of assessing functioning of all family members when working with individuals with ASD and their families.     

Psychosocial effects on siblings of children with autism and mental retardation: a population-based study

The probands of this study were 60 children and young adults between 5 and 20 years of age, 20 of whom had siblings with autism, 20 of whom had siblings with mental retardation, and 20 of whom had siblings who were free of handicap. The three proband groups were matched for gender, birth order and socioeconomic status. The children were questioned about their sibling relationships and about particular problems they faced concerning their handicapped brothers or sisters and about problems concerning themselves. Parents were interviewed about the healthy child's behaviour and social adjustment. Mothers completed the Eysenck Personality Inventory concerning themselves. Siblings of handicapped children and especially siblings of children with autism were more concerned about the future. They also felt lonely more often and many of them had peer problems. They often regarded their handicapped siblings as a burden. They tended to have only one sibling. Siblings often did not know why their handicapped brother or sister was different from other children. There were more behaviour disturbances in the siblings of handicapped children and mothers with a child with autism reported more ‘stressful events’. There were no differences as regards the personality of the mothers and the self-concept of the children between the three groups.     

Applied Behavior Analysis Programs for Autism: Sibling Psychosocial Adjustment During and Following Intervention Use

Psychosocial adjustment in siblings of children with autism whose families were using a home-based, applied behavior analysis (ABA) program was compared to that of siblings in families who were not using any intensive autism intervention. Data gathered from parents, siblings and teachers indicated that siblings in ABA families experienced neither significant drawbacks nor benefits in terms of their behavioral adjustment, sibling relationship quality and self-concept compared to control group siblings, either during or following intervention use. Parents and siblings perceived improvements in sibling interaction since the outset of ABA, with parents somewhat more positive in their views than were siblings. Social support was associated with better sibling outcomes in all groups. Implications for supporting families using ABA are considered.     

Siblings relationships of children with autism

This study investigated sibling relationships of children with autism compared to children with Down syndrome and siblings of normally developing children. Ninety siblings (30 per group) between the ages of 8 and 18 participated in this study. Results indicated that sibling relationships in families of children with autism were characterized by less intimacy, prosocial behavior, and nurturance than those of the two comparison groups. Both siblings of children with autism and siblings of children with Down syndrome reported greater admiration of their sibling and less quarreling and competition in their relationships relative to normally developing comparison children.     

Systems analysis of associations over time between maternal and sibling well-being and behavioral and emotional problems of children with autism

Taking a family systems perspective, several research studies have shown that the family context (especially maternal well-being) predicts psychological adjustment in children with autism. This work has mainly focused on dyadic relationships in the family (especially parent–child reciprocal effects). In the present study, we extended a systems perspective in autism family research to a triad involving the child with autism, their mother, and a sibling, and also adopted a longitudinal design. Mothers from 60 families of children with autism reported on their own depression, and the behavior problems and pro-social behavior of their child with autism and a sibling. Results from longitudinal regression models suggested that earlier levels of maternal depression and sibling pro-social behavior did not have an independent effect on the behavior problems or pro-social behavior of children with autism 2.5–3 years later. Earlier levels of sibling behavior problems were associated with increased behavior problems of the child with autism 2.5–3 years later. Although replication is required, these are the first data to suggest that outcomes for children with autism may be affected by their siblings’ psychological adjustment. The methodology of longitudinal family systems analysis of triadic relationships has important research and practical implications.     

Are typically-developing siblings of children with an autism spectrum disorder at risk for behavioral, emotional, and social maladjustment?

Existing literature regarding the adjustment of siblings of children with an autism spectrum disorder (ASD) remains inconclusive, with some studies showing positive adjustment, others showing negative adjustment, and others showing no difference when compared to siblings of typically-developing children. For the current study, 42 parents of a child with an ASD and a typically-developing sibling (ASD group) and 42 parents of two typically-developing siblings (control group) provided data via online questionnaires. Both diagnostic category and autism symptom severity were tested as possible moderators, but neither produced significant interactions with either externalizing behaviors or internalizing symptoms in the target child when predicting externalizing behaviors, internalizing symptoms, or social problems in the sibling. However, across the overall sample (ASD and control groups), maladjustment - particularly internalizing symptoms - in the target children significantly related to maladjustment in their siblings. Thus, these findings suggest that having a sibling with an ASD is neither a risk nor protective factor for maladjustment among typically-developing siblings above and beyond the relation between maladjustment among siblings in general. Given some of the mixed findings in the literature, other possible moderators that may put siblings of a child with an ASD at specific risk should be considered in future research.     

Behavioral problems and parenting style among Taiwanese children with autism and their siblings

Aims:  The purpose of the present study was to investigate the behavioral problems and parenting style among children with autism and their siblings in an ethnic Chinese population.
Methods:  A total of 151 children with DSM-IV autistic disorder, aged 3–12, 134 siblings without autism, and 113 normally developing controls were recruited. Both parents reported their parenting styles and psychological status and mothers also reported children's behavioral problems.
Results:  Children with autism had significantly more severe behavioral problems and obtained less affection and more overprotection and authoritarian controlling from their parents than the other two groups. Compared to the controls, unaffected siblings showed some behavioral problems, and obtained less maternal care. Withdrawal and attention, social, and thought problems were the most associated behavioral syndromes to distinguish children with autism from those without.
Conclusions:  In addition to children with autism, who have a wide range of behavioral problems and impaired parent–child interactions, their siblings may be at risk for such problems.     

The Prevalence and Psychopathological Correlates of Sibling Bullying in Children with and without Autism Spectrum Disorder

Using data from a prospective population based study, the prevalence and psychopathological correlates of sibling bullying in children with and without autism spectrum disorder (ASD) were estimated. There were 475 children with ASD and 13,702 children without ASD aged 11 years. Children with ASD were more likely to be bullied by their siblings compared to those without ASD. They were also more likely than those without ASD to both bully and be bullied by their siblings, which was associated with lower prosocial skills as well as more internalizing and externalizing problems compared to those not involved in any sibling bullying. Interventions to improve social and emotional outcomes in children with ASD should focus on both the affected and the unaffected sibling.     

Longitudinal Relationships Between Sibling Behavioral Adjustment and Behavior Problems of Children with Developmental Disabilities

Siblings of children with developmental disabilities were assessed twice, 2 years apart (N = 75 at Time 1, N = 56 at Time 2). Behavioral adjustment of the siblings and their brother or sister with developmental disability was assessed. Comparisons of adjustment for siblings of children with autism, Down syndrome, and mixed etiology mental retardation failed to identify group differences. Regression analysis showed that the behavior problems of the child with developmental disability at Time 1, but not the change in their behavior over time, predicted sibling adjustment over 2 years. There was no evidence that this putative temporal relationship operated bidirectionally: sibling adjustment did not appear to be related to the behavior problems of the children with developmental disabilities over time.     

Play Interactions of Family Members Towards Children with Autism

The play interactions of family members towards children with autism were examined in the current study. Siblings, mothers, and fathers of nine families of a child with autism were observed in dyadic play interactions with the child. Results revealed that mothers and fathers exhibited more play behaviors towards children with autism than siblings, while the children with autism initiated more interactions towards siblings than towards parents. Vineland scale scores were correlated with parental behaviors and the initiations of children with autism towards parents. Results suggest that parents may compensate for their child's disability level by initiating more play interactions. Implications include teaching parents how to pace play interactions to allow children with autism to initiate play interactions.     

Social Skills and Behavior Problems in Children with Disabilities with and without Siblings

This study examined social skills and behavior of children with disabilities (CWD) and the impact of siblings on these behaviors. Eighty-five CWD diagnosed with Attention-Deficit Hyperactivity Disorder only (ADHD-o), Learning Disability or Learning Problems (LD/LP), ADHD and LD combined (ADHD/LD) or Spina Bifida (SB) and their siblings were evaluated using standardized social skills and behavior rating scales. The ADHD-o group had significantly lower social skills and more behavior problems than the other groups. There was no recognized effect of the sibling relationship on the social skills and behavioral problems of either the CWD or their siblings. Birth order of the sibling dyads and diagnos(es) of siblings did not have significant influence on the social skills or behavior of CWD. ADHD is a significant risk factor for poor social skills and behavior problems, even when compared with other diagnoses that carry an increased risk of these same problems.     

Emotional and Behavioral Adjustment in Typically Developing Siblings of Children with Autism Spectrum Disorders

Research findings describing the emotional and behavioral functioning of typically developing (TD) siblings of children with autism spectrum disorders (ASD) are contradictory. Methodological issues, such as small study sample sizes and reliance on parent report, may contribute to inconsistent findings. The purpose of this study was to use parent and teacher report to describe presence of internalizing and externalizing behaviors among a large sample (n = 486) of TD siblings of children with ASD. Results indicated that siblings did not exhibit a disproportionate prevalence of internalizing or externalizing symptoms in comparison to the standardization sample of the rating scale. The presence of a sibling with an ASD may not be considered a risk-factor for adjustment problems among TD siblings.     

A controlled trial of the SibworkS group program for siblings of children with special needs

Siblings of children with a disability are an at risk group for emotional and behavioral problems. This study evaluated an intervention to promote the emotional and behavioral functioning of siblings of children with disabilities and chronic health conditions. SibworkS is a six-week manual-based, cognitive–behavioral group support program focussed on strengthening siblings’ perceived social support, self-esteem, problem-solving skills, adaptive coping behaviors and positive sibling relationships. Fifty-six children aged 7–12 were allocated to either the SibworkS program (n = 30) or waitlist control (n = 26) in alternating sequence. The primary outcome was siblings’ emotional and behavioral functioning. Additional outcomes were self-esteem, perceived social support, the sibling relationship and coping behaviors. Siblings were followed-up immediately after the intervention and at 3-months. Siblings participating in the SibworkS intervention were reported to have fewer emotional and behavioral difficulties than siblings in the control group immediately following the intervention and at the 3-month follow-up. Participation in SibworkS was associated with fewer emotional and behavioral difficulties for siblings. Implications for practice and future research include recommendations for improving program participation.     

Sibling Configuration as a Moderator of the Effectiveness of a Theory of Mind Training in Children with Autism: a Randomized Controlled Trial

This RCT investigated whether participants’ sibling configuration moderated the effect of a Theory of Mind (ToM) intervention for children with autism. Children with autism aged 8–13 years (n?=?141) were randomized over a waitlist control or treatment condition. Both having more siblings, as well as having an older sibling were related to better outcomes on measures of ToM-related behavior and social cognition, but not ToM knowledge or autistic features in general. The finding that these associations were limited to practical skills addressed in the intervention, seems to indicate that having more siblings and having an older sibling provides enhanced opportunities for children with autism to practice taught skills in the home environment.

     

Sleep problems among Taiwanese children with autism, their siblings and typically developing children

The current study compared the sleep schedules, sleep problems among children with autism, their siblings and typically developing children, and to explore other associated factors with sleep problems. We conducted a case-control study consisting 110 children with autistic disorder, 125 unaffected siblings, and 110 age-, sex-, and parental education-matched typically developing children, aged 4-13 years old. We conducted psychiatric interviews to obtain DSM-IV diagnosis of autistic disorder and confirmed by the Chinese Version of the Autism Diagnostic Interview-Revised. The mothers were asked to report on the self-administered questionnaires regarding sleep schedules and problems of their children and parenting styles. Our results showed that children with autism had more sleep problems, including early insomnia, middle insomnia, sleep-wake schedule disorders and daytime napping. Their unaffected siblings also had more risk of early insomnia, sleep-talking and nightmares, compared to the typically developing children in non-autistic family. We also found an association between bring-up experience and nightmare, and between maternal overprotection and middle insomnia and sleep-wake schedule disorder. The findings of increased risks for sleep problems in both children with autism and their unaffected sibling suggest that parenting counseling should be included in intervention of sleep problems in children with autism and their siblings.     

Participation in extracurricular activities for children with and without siblings with autism spectrum disorder

Objective: To compare the number, frequency, enjoyment and performance in extracurricular activities of siblings of children with autism spectrum disorders (ASD) to their typically developing (TD) peers, and to identify differences between actual and desired participation. Methods: A case-control study with 30 siblings of children with ASD and 30 siblings of TD children was conducted using the Paediatric Interest Profiles and a questionnaire. Results: Siblings of children with ASD participated in fewer extracurricular activities than those with TD siblings. ASD symptoms were significantly associated with the sibling participating in fewer extracurricular activities. Children with TD siblings had higher enjoyment scores in relaxation activities than children with siblings with ASD. Conclusion: While results were mainly positive, some differences indicated that having a sibling with ASD may impact participation in extracurricular activities. Assessments of participation barriers, as well as support to minimise participation restrictions among siblings of children with ASD are required.     

Preschool siblings of handicapped Children: Interactions with mothers, brothers, and sisters

The purpose of this investigation was to examine similarities and differences between young (aged 3 years to 6 years 9 months) siblings of handicapped and nonhandicapped children in their behavioral interactions with their mothers, brothers, and sisters. Behavior of mothers toward the different groups of children also was examined. Results revealed few differences between sibling groups in the quantity or quality of their interactions with family members. In comparison to the matched control children, siblings of handicapped children engaged in more parallel play and social play, and were more nurturing but no more likely to interact aggressively or to be commanding or directive with their brothers or sisters. Mothers in the experimental group were found to target significantly more nurturant behaviors toward their children compared to control mothers and were significantly more likely to deliver commands, directives, and reprimands to siblings of handicapped children than to any other child. Results are discussed in terms of their correspondence to previous observational and interview research.     

Adjustment of children who have a sibling with Down syndrome: perspectives of mothers, fathers and children

Background A number of methodological weaknesses have contributed to our relatively poor understanding of the impact on children of having a brother or sister with a disability. These include a focus on poor adjustment, using multidiagnostic groups, inadequate matching, and a failure to consider the perspectives of children and parents together. Method This study compared the adjustment of 53 siblings of a child with Down syndrome with a comparison group of siblings of children who were developing typically. Children were matched on a case‐by‐case basis for gender, age and position in family. Families were matched for family size and father’s occupation. The age range of the target siblings was 7–14 years. Data were gathered from mothers, fathers and siblings. Results There were no significant differences between the groups on adjustment measures. These included parent perceptions of externalizing and internalizing behaviours, parent perceptions of sibling competence, and sibling perceptions of their own competence and self‐worth. Associations between measures of adjustment and child reports of their contribution to household functioning depended on sex rather than group membership. There was an association between parental reports of externalizing behaviour and sibling relationships with the brother/sister closest in age. Conclusions Having a brother or sister with Down syndrome does not inevitably lead to poor adjustment. Examination of within‐family processes would appear to be more useful in identifying children at risk than merely group membership.